Clinical and Translational Research
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Pediatr. Mar 9, 2023; 12(2): 38-44
Published online Mar 9, 2023. doi: 10.5409/wjcp.v12.i2.38
Factors associated with subsequent surgery after septic arthritis of the knee in children
Jennifer Marie O’Donnell, Ernest Ekunseitan, Ishaan Swarup
Jennifer Marie O’Donnell, Orthopaedic Surgery, University of California San Francisco, San Francisco, CA 94143, United States
Ernest Ekunseitan, Medical School, University of California San Francisco, San Francisco, CA 94143, United States
Ishaan Swarup, Pediatric Orthopaedic Surgery, UCSF Benioff Children’s Hospital, Oakland, CA 94609, United States
Author contributions: O’Donnell JM, Ekunseitan E, and Swarup I all contributed to this work; O’Donnell JM and Swarup I designed the research study; O’Donnell JM and Ekunseitan E performed the research; O’Donnell JM analyzed the data; O’Donnell JM wrote the manuscript; Ekunseitan E and Swarup I edited and reviewed the manuscript; All authors have read and approve the final manuscript.
Institutional review board statement: This study was exempt by the local institutional review board.
Conflict-of-interest statement: The authors have no conflicts of interest to disclose.
Data sharing statement: The authors will make available all data which are also part of a publicly available database.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ishaan Swarup, MD, Assistant Professor, Pediatric Orthopaedic Surgery, UCSF Benioff Children’s Hospital, 747 52nd Street, Oakland, CA 94609, United States. ishaan.swarup@ucsf.edu
Received: December 1, 2022
Peer-review started: December 1, 2022
First decision: December 13, 2022
Revised: January 13, 2023
Accepted: February 22, 2023
Article in press: February 22, 2023
Published online: March 9, 2023
Abstract
BACKGROUND

Septic arthritis of the knee in children is a challenging problem. Surgical debridement is an established treatment, but there is a paucity of literature on long-term prognosis.

AIM

To determine the rates and factors associated with return to surgery (RTS) and readmission after index surgical debridement for septic arthritis of the knee in children.

METHODS

This is a retrospective cohort study that utilizes data from the Healthcare Cost and Utilization Project (HCUP). We included patients between ages 0 to 18 years that underwent surgical debridement for septic arthritis of the knee between 2005 and 2017. Demographic data included age, gender, race, hospital type and insurance type. Clinical data including index admission length of stay (LOS) and Charlson Comorbidity Index (CCI) were available from the HCUP database. Descriptive statistics were used to summarize the data and univariate and multivariate analyses were performed.

RESULTS

Nine-hundred thirty-two cases of pediatric septic knee were included. This cohort was 62.3% male, with mean age of 9.0 (± 6.1) years. Approximately 46% of patients were white and approximately half had Medicaid insurance. Thirty-six patients (3.6%) required RTS at a minimum of 2 year after index surgery, and 172 patients (18.5%) were readmitted at any point. The mean readmission LOS was 11.6(± 11.3) d. Higher CCI was associated with RTS (P = 0.041). There were no significant associations in age, gender, race, insurance type, or type of hospital to which patients presented. Multivariate analysis showed that both increased CCI (P = 0.008) and shorter LOS (P = 0.019) were predictive of RTS.

CONCLUSION

Septic arthritis of the knee is an important condition in children. The CCI was associated with RTS at a minimum of 2 years after index procedure. No association was found with age, gender, race, insurance type, or hospital type. Shorter LOS and CCI were associated with RTS in multivariate analysis. Overall, risk of subsequent surgery and readmission after pediatric septic knee arthritis is low, and CCI and shorter LOS are predictive of RTS.

Keywords: Septic arthritis, knee, Orthopaedic surgery, Infection, Osteomyelitis, Debridement

Core Tip: Septic arthritis of the knee is an important condition in children. The Charlson Comorbidity Index and shorter length of stay during index admission were associated with return to surgery after index procedure. No association was found with age, gender, race, insurance type, or hospital type. Risk of subsequent surgery and readmission after pediatric septic arthritis of the knee is low; however, presence of comorbidities and shorter length of stay are predictive of subsequent surgery.